Adenocarcinoma cervical e abandono terapêutico: a ótica dos enfermeiros em uma cidade do extremo norte brasileiro / Cervical adenocarcinoma and therapeutic dropouts: the perspective of nurses in a city in the extreme north of brazil / Adenocarcinoma cervical y abandono terapéutico: la perspectiva de los enfermeros de una ciudad del extremo norte de brasil

RESUMO Objetivo: descrever, na perspectiva do enfermeiro, as causas de abandono das usuárias em tratamento do adenocarcinoma cervical e analisar as propostas para diminuir esse abandono. Método: o estudo é descritivo, qualitativo, do tipo investigação narrativa. Participaram sete enfermeiros assistencialistas, atuantes em uma unidade de alta complexidade oncológica, na cidade de Macapá, capital do estado do Amapá, Brasil. O estudo foi realizado no período de três a 20 de dezembro de 2019. Os dados foram submetidos à análise temática categorial. Resultados: emergiram duas categorias: principais causas de abandono das usuárias em tratamento do adenocarcinoma cervical e estratégias do enfermeiro para a diminuição do abandono do tratamento pelas usuárias. Conclusão: para favorecer o resgate das usuárias, os enfermeiros participantes propõem consulta de Enfermagem e um plano de ação multiprofissional, respeitando as singularidades de cada mulher.

ABSTRACT Objective: to describe, from the perspective of nurses, the causes of dropout of users in treatment for cervical adenocarcinoma and analyze the proposals to reduce this dropout. Method: the study is descriptive, qualitative, of narrative research type. Seven care nurses, working in a high complexity oncology unit in the city of Macapá, capital of the state of Amapá, Brazil, participated. The study was conducted in the period from December three to 20, 2019. Data were submitted to categorical thematic analysis. Results: two categories emerged: main causes of dropout of users in treatment for cervical adenocarcinoma and nurse strategies for the reduction of treatment dropout by users. Conclusion: to promote the rescue of the users, the participating nurses propose a Nursing consultation and a multi-professional action plan, respecting the singularities of each woman.

RESUMEN Objetivo: describir, desde el punto de vista del enfermero, las causas de abandono de las usuarias en el tratamiento del adenocarcinoma de cuello uterino y analizar las propuestas para disminuir dicho abandono. Método: El estudio es una investigación descriptiva, cualitativa y narrativa. Participaron siete enfermeros asistenciales, que trabajan en una unidad de oncología de alta complejidad en la ciudad de Macapá, capital del estado de Amapá, Brasil. El estudio se realizó en el periodo comprendido entre el 3 y el 20 de diciembre de 2019. Los datos se sometieron a un análisis categórico temático. Resultados: surgieron dos categorías: principales causas de abandono de las usuarias en el tratamiento del adenocarcinoma cervical y estrategias de los enfermeros para reducir el abandono del tratamiento por parte de las usuarias. Conclusión: para favorecer el resguardo de las usuarias, los enfermeros participantes proponen una consulta de Enfermería y un plan de acción multiprofesional, resaltando las singularidades de cada mujer.

Supportive care needs and quality of care of patients with lung cancer in Mexico: A cross-sectional study.

PURPOSE: To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico. METHODS: We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs. RESULTS: One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs-predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety. CONCLUSION: PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring.

Liposomal Irinotecan: Nursing Considerations in an Outpatient Cancer Center

Recent approaches in treating pancreatic adenocarcinoma, an aggressive disease with limited survival, include the use of liposomal irinotecan as an option when first-line therapy has failed. Liposomal irinotecan has been approved in combination with 5-fluorouracil and leucovorin for patients with metastatic pancreatic cancer. Liposomal irinotecan is a newer therapy requiring oncology nurses to obtain knowledge and skills for proper administrating, monitoring of hypersensitivity reactions during infusion, managing side effects, and providing patient education. Nursing considerations when administering this drug include infusion time, premedication, risk for hypersensitivity reactions and adverse events, and side effects.

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life / Sobrecarga do cuidador familiar: a sobrecarga de cuidar de pacientes com câncer de pulmão, de acordo com o estágio do câncer e a qualidade de vida do paciente

ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.

RESUMO Objetivo: Pacientes com câncer de pulmão vivenciam diferentes sentimentos e reações, dependendo de sua formação familiar, social, cultural e religiosa, que são fonte de grande sofrimento, não só para os pacientes mas também para seus cuidadores familiares. Este estudo objetivou avaliar o impacto do estágio do câncer de pulmão e da qualidade de vida (QV) dos pacientes com câncer de pulmão na sobrecarga do cuidador. Métodos: Estudo prospectivo transversal. Díades paciente-cuidador foram selecionadas consecutivamente e solicitadas a preencher a Hospital Anxiety and Depression Scale e o Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Os cuidadores familiares também preencheram a Caregiver Burden Scale. Utilizou-se a modelagem de grupos para identificar pacientes com câncer em estágio inicial ou avançado (IA a IIIA vs. IIIB a IV) mais QV não comprometida ou comprometida (pontuação total no SF36 > 50 vs. ≤ 50). As díades paciente-cuidador foram estratificadas em quatro grupos: câncer em estágio inicial+QV não comprometida; câncer em estágio avançado+QV não comprometida; câncer em estágio inicial+QV comprometida; e câncer em estágio avançado+QV comprometida. Resultados: Foram incluídas 91 díades paciente-cuidador. A maioria dos pacientes era do sexo masculino e grande fumante. Os cuidadores familiares eram mais jovens e predominantemente do sexo feminino. A sobrecarga, QV, nível de ansiedade e nível de depressão dos cuidadores foram mais afetados pela QV dos pacientes do que pelo estágio do câncer de pulmão. Os cuidadores familiares dos pacientes com QV comprometida apresentaram maior mediana de sobrecarga do que os dos pacientes com QV não comprometida, independentemente do estágio da doença. Conclusões: A sobrecarga do cuidador é mais afetada pela QV do paciente do que pelo estágio do câncer de pulmão.

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life.

OBJECTIVE:: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. METHODS:: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. RESULTS:: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. CONCLUSIONS:: Caregiver burden is more affected by patient QoL than by lung cancer stage. OBJETIVO:: Pacientes com câncer de pulmão vivenciam diferentes sentimentos e reações, dependendo de sua formação familiar, social, cultural e religiosa, que são fonte de grande sofrimento, não só para os pacientes mas também para seus cuidadores familiares. Este estudo objetivou avaliar o impacto do estágio do câncer de pulmão e da qualidade de vida (QV) dos pacientes com câncer de pulmão na sobrecarga do cuidador. MÉTODOS:: Estudo prospectivo transversal. Díades paciente-cuidador foram selecionadas consecutivamente e solicitadas a preencher a Hospital Anxiety and Depression Scale e o Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Os cuidadores familiares também preencheram a Caregiver Burden Scale. Utilizou-se a modelagem de grupos para identificar pacientes com câncer em estágio inicial ou avançado (IA a IIIA vs. IIIB a IV) mais QV não comprometida ou comprometida (pontuação total no SF36 > 50 vs. ≤ 50). As díades paciente-cuidador foram estratificadas em quatro grupos: câncer em estágio inicial+QV não comprometida; câncer em estágio avançado+QV não comprometida; câncer em estágio inicial+QV comprometida; e câncer em estágio avançado+QV comprometida. RESULTADOS:: Foram incluídas 91 díades paciente-cuidador. A maioria dos pacientes era do sexo masculino e grande fumante. Os cuidadores familiares eram mais jovens e predominantemente do sexo feminino. A sobrecarga, QV, nível de ansiedade e nível de depressão dos cuidadores foram mais afetados pela QV dos pacientes do que pelo estágio do câncer de pulmão. Os cuidadores familiares dos pacientes com QV comprometida apresentaram maior mediana de sobrecarga do que os dos pacientes com QV não comprometida, independentemente do estágio da doença. CONCLUSÕES:: A sobrecarga do cuidador é mais afetada pela QV do paciente do que pelo estágio do câncer de pulmão.

Understanding immunotherapy for the treatment of non-small cell lung cancer.

Patients diagnosed with advanced non-small-cell lung cancer (NSCLC) (either squamous or non-squamous) have previously had limited treatment options after progression on chemotherapy. With the emergence of new drugs, particularly in the immuno-oncology setting, this is now changing. Recent clinical trial evidence demonstrates that compared with docetaxel, patients who received nivolumab had better overall survival and also significantly fewer grade 3-4 adverse events. This article reviews the clinical trial data for nivolumab and provides an overview of how this drug works. The adverse event profile of nivolumab is assessed and compared to that of docetaxel. The important role that nurses can play in supporting patients on nivolumab is also discussed.

Yttrium-90 radioembolization as a palliative treatment for liver tumors: a case study.

The best chance of cure for patients with liver cancer is surgical removal, but many tumors are too large or invasive. In addition, chemotherapy is frequently unsuccessful in this patient population. A case study is featured involving a patient determined to be a candidate for Yttrium-90 radioembolization, a minimally invasive liver-directed treatment used to target primary and metastatic liver tumors by delivering radioactive microspheres directly to the tumor. This article provides an introduction to the procedure, as well as practical information for nurses caring for patients with liver cancer following Yttrium-90 radioembolization.AT A GLANCE: Yttrium-90 radioembolization allows larger radiation doses to be used without affecting healthy tissues.An outpatient procedure, Yttrium-90 radioembolization results in fewer side effects than standard treatment.
Although Yttrium-90 radioembolization can extend and improve quality of life, its intent is palliative, not curative.

Improving couples' quality of life through a Web-based prostate cancer education intervention

PURPOSE/OBJECTIVES: To evaluate the feasibility and acceptability of a newly developed web-based, couple-oriented intervention called Prostate Cancer Education and Resources for Couples (PERC). DESIGN: Quantitative, qualitative, mixed-methods approach. SETTING: Oncology outpatient clinics at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center at UNC­Chapel Hill. SAMPLE: 26 patients with localized prostate cancer (PCa) and their partners. METHODS: Pre- and postpilot quantitative assessments and a postpilot qualitative interview were conducted. MAIN RESEARCH VARIABLES: General and PCa-specific symptoms, quality of life, psychosocial factors, PERC's ease of use, and web activities. FINDINGS: Improvement was shown in some PCa-specific and general symptoms (small effect sizes for patients and small-to-medium effect sizes for partners), overall quality of life, and physical and social domains of quality of life for patients (small effect sizes). Web activity data indicated high PERC use. Qualitative and quantitative analyses indicated that participants found PERC easy to use and understand,as well as engaging, of high quality, and relevant. Overall, participants were satisfied with PERC and reported that PERC improved their knowledge about symptom management and communication as a couple. CONCLUSIONS: PERC was a feasible, acceptable method of reducing the side effects of PCa treatment­related symptoms and improving quality of life. IMPLICATIONS FOR NURSING: PERC has the potential to reduce the negative impacts of symptoms and enhance quality of life for patients with localized PCa and their partners, particularly for those who live in rural areas and have limited access to post-treatment supportive care.

["And suddenly I have a tumor" - the situation of family S./N]. / «Und plötzlich habe ich einen Tumor¼ - Die Situation von Frau S. und ihrer Familie.

BACKGROUND: Many families affected by a terminal illness need professional help and support. In order to be able to cope with emotional stress, loss of light-heartedness and changes in family structure thorough information is important for patients and their families. The Calgary Family-Assessment and Calgary Family Intervention-Model are suitable to determine the needs of concerned families and hence to offer appropriate interventions. PURPOSE: In an instrumental case study the situation of Mrs. S.2 and her family was analyzed. Mrs. S. is suffering from an inoperable adenocarcinoma. METHOD: An assessment classified the different information given during the first meeting and determined the focus of the interventions. RESULTS: Interventions concentrated on cognitive and emotional support. CONCLUSIONS: The case study showed how family models for nurses could systematically guide professionals in supporting families. Listening and spending time with the concerned person and their families showed to offer important factors, which were perceived as very helpful by the families.

Effects of an early postoperative walking exercise programme on health status in lung cancer patients recovering from lung lobectomy.

AIMS AND OBJECTIVES: To examine the effects of an early postoperative walking exercise programme on postlobectomy lung cancer patients. BACKGROUND: Few interventional studies on the postoperative health status of lung cancer patients have considered the efficacy of programmes designed to improve critical health variables. DESIGN: A two-group quasi-experimental, longitudinal approach repeated four times examined participant data collected 12-18 hours prior to surgery and again at one, three and six months after surgery. METHODS: We assigned the first 33 enrolled participants to the intervention group and the second 33 to the control group. The intervention was a daily supervised walking exercise programme consisting of 12 weeks of brisk walking exercise that began on the day following transfer to the regular ward along with weekly telephone calls until 12 weeks after discharge. Health status was measured using a structured questionnaire (World Health Organization Quality of Life, brief version) and clinical tests (pulmonary function test and 6-minute walk test). We analysed data using general estimating equations, with p < 0·05 considered significant. RESULTS: Intervention group pulmonary and physical functions were increasingly better over time than those of the control group, with no significant difference in quality of life between the two groups. Compared to the control group, the intervention group earned significantly better values for FVC% at postoperative month 3 and for FEV1 % at postoperative months 3 and 6. Intervention group 6MWT scores were significantly better than those of the control group at postoperative months 1, 3 and 6. CONCLUSION: This study demonstrated the benefits of an early postoperative walking exercise intervention for pulmonary and physical function in postlobectomy lung cancer patients. RELEVANCE TO CLINICAL PRACTICE: The results may guide the design of appropriate interventions in the future. Clinical trials in other populations are needed to confirm the results of this study.

Androgen-deprivation therapy and metabolic syndrome in men with prostate cancer.

PURPOSE/OBJECTIVES: To examine the trajectory of changes in body composition and metabolic profile in men who receive androgen-deprivation therapy (ADT) for prostate cancer. DESIGN: Prospective longitudinal design with repeated measures. SETTING: Urban medical center in the southwestern United States. SAMPLE: 55 men starting radiation therapy for prostate cancer. METHODS: Changes in the parameters of metabolic syndrome were estimated with ADT (n=31) and non-ADT (n=24) groups by repeated-measures analysis of variance implemented by general linear mixed-effects models. Models included interactions between groups and follow-up time to test differences between the groups. MAIN RESEARCH VARIABLES: Body composition and metabolic variables. FINDINGS: The ADT group demonstrated a transient increase in waist circumference at the nine-month time point and significant changes in measures of insulin resistance were noted at the three month point. Values for diastolic and systolic blood pressure, plasma glucose, high-density lipoprotein, and triglycerides were not altered for either group. Differences in metabolic variables or measures of body composition did not differ significantly between the groups. CONCLUSIONS: The findings demonstrate the development of insulin resistance in men receiving ADT as early as three months after starting ADT. IMPLICATIONS FOR NURSING: Addressing survivorship concerns can lead to the development of nursing interventions designed to reduce adverse effects associated with ADT.

Factors relating to quality of life after esophagectomy for cancer patients in Taiwan.

BACKGROUND: Little is known regarding the short-term quality of life (QoL) and predictive factors for QoL after esophagectomy for cancer in Eastern countries. OBJECTIVE: The aims of this study were to assess QoL and symptoms within 1 and 6 months after surgery for esophageal cancer (EC) and to identify factors predictive of QoL within 6 months after esophagectomy in Taiwan. METHODS: A longitudinal, prospective design was used, where convenience samples of 99 patients who had undergone esophagectomy for cancer were recruited from 2 medical centers in northern Taiwan. All participants responded to a questionnaire with a QLQ-C30 (Quality of Life Questionnaire-Cancer) core and a QLQ-OES18 (esophageal module of the European Organization for Research and Treatment [EORTC] QLQ-C30) module in structured interviews at baseline and 1 and 6 months after surgery. RESULTS: The results showed significant decline in social function and global QoL; fatigue, insomnia, eating problems, reflux, and dry mouth were major problems within 6 months. Body mass index, body weight loss before surgery, activity performance status, and anastomosis site showed no significant association with the function and symptom aspect of QoL. Surgical complications, advanced cancer, neoadjuvant therapy before surgery, and tumor location other than at the EC junction had significant deleterious effects on several aspects of QoL. CONCLUSIONS: This study describes the demographics of EC and short-term changes in QoL and also the predictive impact factor for QoL after surgery for EC. IMPLICATIONS FOR PRACTICE: Knowledge of risk factors for poor postoperative QoL would be useful for health providers in detecting and prioritizing problems and treatment options in a busy clinical site.

Exercise preferences among men with prostate cancer receiving androgen-deprivation therapy.

PURPOSE/OBJECTIVES: To investigate acceptability of and preferences for physical activity participation in men receiving androgen-deprivation therapy (ADT) for prostate cancer, to identify influencing clinical and demographic factors, and to determine the percentage meeting national exercise guidelines. DESIGN: Cross-sectional, descriptive. SETTING: Ambulatory care clinic of a large medical center. SAMPLE: 135 men receiving ADT. METHODS: A structured interview with a systematic procedure was used to elicit preferences for physical activity. MAIN RESEARCH VARIABLES: Exercise preferences and acceptability; evidence-based exercise intervention. FINDINGS: Participants expressed high levels of acceptability of and willingness to participate in aerobic (64% and 79%) and muscle-strengthening (79% and 81%) programs. Preferences were expressed for muscle-strengthening activities performed at home, either alone or in the company of a family member. Flexible, spontaneous, and self-paced programs were preferred. Significant associations were identified for distance, age, obesity, duration of ADT, and meeting American College of Sports Medicine (ACSM) and American Heart Association (AHA) guidelines. Nineteen percent of the study population met the guidelines for weekly physical activity. CONCLUSIONS: High levels of expressed acceptance of and willingness to participate in physical activity programs as well as the small number of participants meeting ACSM and AHA guidelines suggest feasibility of and support the need for the development of exercise programs in this population. IMPLICATIONS FOR NURSING: Incorporating patient preferences and evidence-based practice is integral to providing high-quality patient-centered care and is the foundation for appropriate intervention programs. Insight from this study will facilitate the design of programs that better reflect actual preferences of prostate cancer survivors. KNOWLEDGE TRANSLATION: ADT-induced changes in body composition are believed to contribute to a reduction in insulin sensitivity and dyslipidemia that contribute to increased cardiovascular risk profile. Exercise has the potential to mitigate the harmful effects of ADT.

The lived experience of men diagnosed with prostate cancer.

PURPOSE/OBJECTIVES: To investigate the lived experience of prostate cancer from a patient perspective. RESEARCH APPROACH: Descriptive, qualitative. SETTING: Community setting. PARTICIPANTS: 10 men with prostate cancer aged 62-70 years. METHODOLOGIC APPROACH: A hermeneutic phenomenologic method using semistructured, open-ended questions addressing the lived experience. DATA SYNTHESIS: Phenomenology of praxis proposed by van Manen guided the data analysis and transformed personal experiences into disciplinary understanding. FINDINGS: The use of van Manen's method of inquiry and analysis has contributed to the findings of the study by providing a way to explore the meaning of the lived experiences in an attempt to understand living with prostate cancer. Several themes were identified: living in the unknown, yearning to understand and know, struggling with unreliability of body, bearing the diagnosis of cancer, shifting priorities in the gap, and feeling comfort in the presence of others. CONCLUSIONS: Oncology nurses can use van Manen's four fundamental existentials-lived space (spatiality), lived body (corporeality), lived time (temporality), and lived other (relationality)-to understand the lived experience of prostate cancer. Nurses have many opportunities to impact the lives of men diagnosed with prostate cancer, including diagnosis, management of physical integrity, management of psychosocial integrity, and providing education. INTERPRETATION: Nurses may encourage men to describe their diagnosis story and illness experience to better understand the meaning of the prostate cancer experience and to provide appropriate nursing care.

Incidence of preventable postoperative readmissions following pancreaticoduodenectomy: implications for patient education.

PURPOSE/OBJECTIVES: To determine readmission rates post-pancreaticoduodenectomy (PD), readmission reasons following PD, and patients' postoperative education prior to discharge. DESIGN: Retrospective, descriptive study of established medical records of patients who have undergone PD from 2006-2008. SETTING: PD cohort from a pancreatic cancer program. SAMPLE: 62 patients aged 18 years or older, diagnosed with pancreatic cancer, who had PD. METHODS: Data abstracted from inpatient and outpatient electronic records as per study protocol and entered into Excel® spreadsheet for analysis. MAIN RESEARCH VARIABLES: Incidences of and reasons for readmissions post the PD procedure. Discharge education given to patients prior to discharge. FINDINGS: Patients were discharged at mean postoperative day 11.3. Readmission rate was 28%. Reasons for readmission were dehydration or malnutrition (n = 10, 16%) and surgical site infection (n = 7, 11%); 10% of patients (n = 6) had documented difficulties with dehydration, malnutrition, and failure to thrive noted at follow-up. PD discharge teaching was documented in a mandatory discharge form. No standard curriculum was used. CONCLUSIONS: Patients undergoing PD experience an increase in self-care demand postdischarge. Poor discharge education can lead to high rates of readmission, specifically for dehydration and malnutrition, mandating an assessment of patient education prior to discharge. IMPLICATIONS FOR NURSING: Close attention must be given to the needs of patients with pancreatic cancer postdischarge. Trying to identify the areas of educational deficit at patient readmission could help nurses identify what they can do to minimize preventable complications. Educational focus for patients undergoing PD should be on prevention of dehydration, malnutrition, and surgical site infections.

Instrumental care and human-centered caring: rhetoric and lived reality.

This article explores the nursing discourse on relational caring as a context for examining the authors' recent lived realities with the health care system. Two narratives detail experiences of instrumental care and human-centered caring as the authors journeyed with a loved one who was dying. Commonalities across the stories are identified and caring analyzed using Halldorsdottir's ways of being with another. From weaving an analysis of the realities with the literature emerges a recognition of a critical turning point in nursing and health care.